Pattern of Otorhinolaryngolic Diseases in Geriatric Population

Objective- To determine the pattern of otorhinolaryngological disorders in geriatric population and to establish a correlation with socioeconomic factors. Methods- A total of 1020 geriatric patients who attended the otorhinolaryngology department were included in the study. They were subjected to brief history, examination and the socioeconomic status. Results were analyzed by using appropriate statistical tests analyzing percentage and proportion. BG. Prasad’s classification was used to categories patients into classes based on the socioeconomic status of an individual. Investigations pertaining to the system involved were carried out and the diagnosis was made according ly. Results- The most common affected organ was ear (33%) and the most common disease diagnosed among geriatric patient assessed was presbycusis (25.2%). Although epistaxis, chronic pharyngitis and malignancy larynx were also commonly diagnosed. Among all patients’ males was on the lead and the middle-class patients mostly attended the otorhinolaryngology department. Conclusion- In present study the male patients formed the major bulk of geriatric patients. The majority of geriatric patients belonged to age group between 60 to 70years and most of them belonged to middle socioeconomic class. The aim of our study was to find out the pattern of otorhinolaryngological diseases in which we observed that most common affected organs among the geriatric patients was ear. Presbycusis out of all disorder was the most common ear disease among geriatric patients

Pre-Operative Predictors of Ossicular Status in Chronic Supportive Otitis Media

Introduction: Chronic suppurative otitis media is associated with ossicular necrosis. Both safe and unsafe CSOM have incidence of ossicular necrosis. This study will provide the much-needed insight, into the factors which can act as significant predictors for the intra operative ossicular status, and help in better preparing the patient before the surgery and need for ossiculoplasty. Furthermore, narrowing down to the most significant ly related predictors, it may also be»possib1eto reduce the financial burden on the patient, something which is of prime importance in a resource limited country like ours. Objectives: pre-operative predictors of intra operative ossicular status in chronic suppurative otitis media and effect of duration of disease on hearing threshold and ossicular-status. Material and methods: A descriptive observational study was done in a Tertiary care referral center. A total number of 124 patients with the clinical diagnosis of CSOM were selected from outpatient department and admitted. All patients were subjected to otoendoscopy, X-raymastt), 1d (Schiller’s view) and pure tone audiometry. All patients underwent tympanomastoidectomy. Preoperative findings on the basis of history, examination and investigations were noted along with findings of intraoperative ossicular status. Findings were tabulated and statistical test were applied to determine significant preoperative predictors of iv intraoperative ossicular status. Results: Intraoperative ossicular necrosis was seen in a total number of 43 patients. On; univariate analysis, blood-stained discharge (P<0.0001), purulent consistency of ear discharge (0<0.0()01), associated symptoms of vertigo (p=0.0047), otalgia (p=0.0019), size(p=0.0042) and f site(p=0.004l), severity of hearing loss (p=0.004), sclerotic mastoid air cell (p=0.0001) had significant association with ossicular necrosis. The duration of disease and hearing threshold did not have statistically significant association (p=0.227). Conclusion: Ossicular necrosis is best indicated by the presence blood-stained and purulent discharge, vertigo, otalgia, total perforation, severe degree of hearing loss and sclerosed mastoid. Incus was the most common necrosed ossicle followed by malleus followed by stapes, Duration of disease did not have a significant connotation with hearing threshold

Study of Mastoid Antral Changes in Tubotympanic Chronic Supportive Otitis Media

Background: Study of mastoid antrum findings in tubotympanic chronic suppurative otitis media Objectives: To study mastoid antrum findings in tubotympanic CSOM and to determine predictors for performing antrostomy. Methodology: 71 patients with tubotympanic CSQM were selected from OPD and IPD. All patients were subjected to investigations like X—ray mastoid (Schuller’s View), pure tone audiometry and Otoendoscopy. All patients were subjected to mastoid exploration (cortical mastoidectomy or antrostomy) with tympanoplasty. Pre-Operative findings on basis of history, examination and investigations were noted along with intra-operative findings of middle ear and mastoid antrum. Findings were tabulated and statistical tests were applied to determine significant predictors. Results: Mastoid antrum was found to be diseased in 21 patients with pathological findings like mucopus, granulations etc. Recurrent URTI, mastoid pneumatization pattern, pre operative middle ear mucosal status on otoendoscopy, degree of hearing loss and ossicular status were significantly associated with diseased antrum (P-value<0.05). Conclusion: Disease can be found in mastoid antrum in tubotympanic CSOM. Mastoid exploration in form of antrostomy should be done in all cases where certain predictors are present. The predictors for performing antrostomy in tubotympanic disease are presence of recurrent URTI on history, sclerotic mastoid on x—ray mastoid (Schuller’s View), unhealthy middle ear mucosa on otoendoscopy, moderate and moderately severe hearing loss on pure tone audiometry and intra-operative ossicular necrosis and immobility

Analysis of Stutterers Characteristics in Association with Age of Onset and Family History of Stuttering

Introduction Stuttering is a common occurrence in children which is also known as stammering, dysfluency or clutching of words. Aims of present study was to study association of age of onset and family history of stuttering with stutterers characteristics.  Materials and Methods Total 136 stutterers were included in the study.  All stutterers were subjected to complete ear nose and throat examination. All stutterers were evaluated by speech language therapist for diagnosis of speech disorder. Results Out of 136 stutterers 124 (91%) were male while 12 (9%) were female ranging from 6 years to 56 years, 15 (11%) had age of onset below 3 years, 98 (72%) had 3 years to 6 years while 23 (17%) had onset after age of 6 years, 44 (36.4%) male and 1 (8.3%) female patient had first degree family history of stuttering, 15 (11%) had mild stuttering, 98 (72%) had moderate stuttering while 23 (17%) had severe stuttering, 102 (75%) had secondary stuttering characteristics including 94 (75.8%) male and 8 (67%) female stutterers. Conclusion Present study concluded that there is definite association of between age of onset and severity of stuttering, between duration of stuttering and secondary characteristics and between severity and number of secondary characteristics of stuttering. We couldn’t find significant association between positive family history of stuttering among first degree relatives and age of onset, severity and secondary characteristics of stuttering.  

Clinical Presentation and Outcome of Sinonasal Mucormycosis in Pre COVID-19 Era from a Tertiary Care Centre in Uttarakhand: A Cross-sectional Study

Introduction: Sinonasal mucormycosis is an invasive fungal rhinosinusitis which rapidly involves orbits and brain either by direct extension or angioinvasion. Uncontrolled diabetics and immunocompromised patients are prone for this invasive fungal infection. The rapidity of severity of symptoms and morbidity of this invasive fungal infection warrant earliest diagnosis and appropriate management. This research work will be helpful in comparing sinonasal mucormycosis in Coronavirus Disease2019 (COVID-19) patients as all cases in present study were not associated with COVID-19 infection. Aim: To observe presenting features and estimate morbidity of mucormycosis patients in tertiary care hospital. Materials and Methods: This cross-sectional retroprospective study was conducted in Department of Otorhinolaryngology of a tertiary teaching hospital from July 2018 to March 2020. Total 25 sinonasal mucormycosis patients who underwent endoscopic debridement along with amphotericin B were included in this study. Patient was analysed regarding age, gender, chief complains, accompanying co-morbidity, extension of disease, medical treatment, surgical intervention and final outcome. Statistical analysis was done in the form of mean, mode, median and percentage wherever required. Results: Total 14 (56%) patients were male and 11 (44%) patients were female with median age of 48 years. Total 13 (52 %) patients had facial pain or headache while 13 (52%) had facial or orbital swelling followed by nasal symptoms in 5 (20%), vision loss in 4 (16%) and ptosis in 3 (12%) cases. Twenty four (96%) of cases were having uncontrolled diabetes mellitus. Only 3 (12%) had limited sinonasal disease while 22 (88%) had fungal invasion in orbit. Total 7 (28%) patients had intracranial extension. Out of 25 patients, 4 (16%) expired, 7 (28%) had permanent vision loss and 12 (48%) recovered completely and 2 (8%) left hospital against medical advice. Conclusion: Present study concluded that mucormycosis is strongly associated with uncontrolled diabetes mellitus. Most common presenting features were facial pain, headache and facial orbital swelling. Only half of the patients recovered with minimal morbidity. Mortality is associated with intracranial extension of mucormycosis. Early diagnosis, extensive and timely endoscopic debridement and appropriate use of amphotericin B is key for treatment of black fungus

Evaluation of testicular workup for ischemia and suspected torsion score in patients presenting with acute scrotum

Background: Testicular torsion is one of the causes of acute scrotum and it requires timely evaluation and surgical treatment. Color Doppler is considered investigation of choice, but it may delay treatment, as, many times, it may not be available for emergency situations. Barbosa et al. created Testicular Workup for Ischemia and Suspected Torsion (TWIST) score based on clinical parameters for clinical diagnosis of testicular torsion. We have evaluated this score in our population. Materials and Methods: We retrospectively calculated TWIST score in patients of acute scrotum admitted to tertiary teaching institute. Patients without complete TWIST score were excluded from the study. The scoring system consisted of testicular swelling (2 points), hard testicle (2), absent cremasteric reflex (1), nausea/vomiting (1), and high-riding testis (1). Statistical analysis was done to evaluate the validity of scores. Results: A total of 118 patients were included in the study, out of which 45 (38%) patients had testicular torsion. The mean age of patients was 16.6 years in testicular torsion patients and 15.2 years in other patients. Cutoff for low-risk and high-risk patients was two and five, respectively. Fifty percent, 26.2%, and 23.8% of patients were present in low-, intermediate-, and high-risk groups. Negative predictive value of TWIST score for low-risk patients was 96.61% while positive predictive value for high-risk patients was 92.86%. Conclusions: TWIST score has high predictive value and can be used for clinical diagnosis of testicular torsion. It can decrease the need of color Doppler in about 50% of cases and can prevent delay in treatment